Form 260.110 - Application For Qualification Of The Offer And Sale Of Securities (Page 2 of 2) in pdf

Form 260.110 - Application For Qualification Of The Offer And Sale Of Securities Page 2

_______________________________________________________________________________

(a)

(b)

(c)

(d)

(e)

Description of

Total number of

Proposed

Does a public

Securities (See

shares or units

maximum

market exist for

Instructions on

of each class of

offering price

aggregate

this class of

reverse side)

securities being

per unit (e.g.,

offering price

securities?

qualified in

"$10")

for securities

(indicate "yes"

California (e.g.,

being qualified

or "no". If

"$20,000")

in California

"yes" insert

(e.g.,

CUSIP number)

"$200,000")

Note: Fee

calculated on

total of this

column

____________

6. Consideration to be paid for securities; if cash, state "cash", or if other than cash and the

aggregate value is ascribed thereto by the board of directors of the issuer so state (e.g., "Real

Property, $100,000," "Assets of a Going Business, $50,000").

7. There is no adverse order, judgment or decree entered in connection with the offering by any

State regulatory authority, any court or the Securities and Exchange Commission, except as

follows: (if none, so state.)

______________________________________________________________________________

260.110 (Rev 7/93, Register 1993, No. 27)

Form 260.110 - Application For Qualification Of The Offer And Sale Of Securities Page 2

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